RESUMO

Objective: Knee genicular nerve blocks have been a topic of discussion among various types of treatment for knee osteoarthritis. This study aims to evaluate the pain and function of patients diagnosed with knee osteoarthritis after undergoing ultrasound-guided genicular nerve blockade using pharmacological agents. Methods: The study included 36 patients diagnosed with knee osteoarthritis, comprising 17 bilateral cases, totaling 53 knees undergoing UGNB using a mixture of triamcinolone, ropivacaine, and lidocaine under ultrasound guidance. Epidemiological data, pain outcomes measured by the Visual Analog Scale (VAS), and function assessed using the Western Ontario and McMaster Universities (WOMAC) score were evaluated before and after 12 weeks of the procedure. Results: The mean age was 75.5 years (standard deviation of 9.4 years), with a predominance of females and right-sided involvement. There was a mean reduction of 3.0 points in VAS (p < 0.001) and 15.4 points in WOMAC (p < 0.001). Two cases reported only minor and transient complications related to the procedure (skin anesthesia and edema). Conclusion: Ultrasound-guided genicular nerve blockade using pharmacological agents demonstrated pain reduction and improved function with a low complication rate after 12 weeks in patients with knee gonarthrosis. Level of Evidence IV, Case Series.

Objetivo: Os bloqueios geniculares do joelho têm sido tema de discussão entre os diversos tipos de tratamento da gonartrose. Este estudo tem por objetivo avaliar a dor e a função dos pacientes com diagnóstico de osteoartrose do joelho, após realização do procedimento de bloqueio farmacológico dos nervos geniculares (BFNG) guiado por ultrassom. Métodos: O estudo incluiu 36 pacientes com diagnóstico de gonartrose, sendo 17 casos bilaterais, totalizando 53 joelhos submetidos ao BFNG, com a mistura de triancinolona, ropivacaína e lidocaína guiado por ultrassom. Avaliou-se dados epidemiológicos, desfechos de dor pela Escala Visual Analógica (EVA) e função com escore Western Ontario and Mcmaster Universities (WOMAC) antes e após 12 semanas do procedimento. Resultados: A idade média encontrada foi de 75,5 anos (desvio padrão de 9,4 anos), com predominância do sexo feminino e do lado direito. Houve uma redução média na EVA de 3,0 pontos (p < 0,001) e no WOMAC de 15,4 (p < 0,001). Em dois casos, relataram apenas complicações menores e transitórias relacionadas ao procedimento (anestesia da pele e edema). Conclusão: O bloqueio farmacológico dos nervos geniculares guiado por ultrassom demonstrou redução da dor e melhora na função, com baixa taxa de complicação após 12 semanas nos pacientes com gonartrose. Nível de evidência IV, Série de Casos.

RESUMO

Objective: The objective of the research was to carry out a comparative study between Smith & Nephew ® or Zimmer ® prostheses with thick versus thin polyethylene, in patients undergoing primary total knee arthroplasty, during a short-term follow-up. Thus, the objective was to analyze the survival of the implants in question under the clinical and radiographic aspect. Methods: The sample was divided into two groups: Group 1 with thick polyethylene and group 2 with thin polyethylene. A clinical analysis of the patients was carried out and the implants were checked for loosening. Results: The groups were similar when compared. According to the Ahlbäck classification, 83% of the patients were in groups IV and V. The median functional score in the postoperative period was similar between the two groups. Postoperatively, the tibiofemoral angle fluctuated between 5 and 6 0 valgus on average. Two complications were observed in each group. None of the evaluated patients presented implant loosening. Conclusion: Patients treated with thick polyethylene had the same functional score as the control group, as well as the absence of radiographic changes in this short-term follow-up, with implant survival and a similar rate of complications between both groups. Level of evidence III, Retrospective study.

Objetivo: O objetivo desta pesquisa foi realizar um estudo comparativo entre as próteses Smith & Nephew ® e Zimmer ®, com polietileno espesso versus o fino, em pacientes submetidos à artroplastia total primária do joelho, durante um seguimento de curto prazo. Dessa forma, foi analisada a sobrevida dos implantes em questão sob o aspecto clínico e radiográfico. Métodos: A amostra foi dividida em dois grupos: grupo 1 com polietileno espesso e grupo 2 com polietileno fino. Foi realizada análise clínica dos pacientes e verificado se ocorreu soltura dos implantes. Resultados: Os grupos tiveram resultados semelhantes quando comparados. Segundo a classificação de Ahlbäck, 83% dos pacientes eram dos grupos IV e V. A mediana do escore funcional no pós-operatório foi similar entre os grupos. No pós-operatório o ângulo tíbio-femoral oscilou na média entre 5 e 6 0 de valgo. Foram observadas duas complicações em cada grupo. Nenhum dos pacientes avaliados apresentou soltura do implante. Conclusão: Os pacientes tratados com o polietileno espesso apresentaram o mesmo escore funcional do grupo controle, assim como ausência de alterações radiográficas nesse seguimento de curto prazo, com sobrevida do implante e índice de complicações similar entre ambos os grupos. Nível de evidência III, Estudo retrospectivo.

RESUMO

INTRODUCTION: Knee pain is a major cause of disability worldwide, particularly among the elderly. Current treatments, including nonsteroidal anti-inflammatory drugs and analgesics, often lead to adverse effects. Krill oil is being explored as a potential alternative, however its efficacy in managing knee symptoms remains unclear. METHODS: MEDLINE, Embase, and Cochrane databases were searched until May 2024 for studies comparing krill oil and placebo in knee pain patients. Endpoints included knee pain, stiffness, physical function, and lipid profiles (HDL-C, LDL-C, triglycerides, and total cholesterol). A restricted maximum likelihood random-effects model with standardized mean differences (SMD) and 95% confidence intervals (CI) was used. A trial sequential analysis was conducted to evaluate further research implications. RESULTS: We included five trials with 700 patients using krill oil for knee pain. Results showed no significant difference between krill oil and placebo for knee pain, knee stiffness, and lipid profiles. However, krill oil demonstrated a significant small effect in improving knee physical function (SMD -0.24, 95% CI [-0.41; -0.08], I2 = 0%).Trial sequential analysis provided certainty that krill oil enhances knee physical function compared to placebo and indicated no improvement in knee pain, but the findings for knee stiffness need to be confirmed by further research. CONCLUSION: This study found that krill oil supplementation did not significantly improve knee pain, stiffness, or lipid profile, although it may help knee physical function. Based on these findings, krill oil supplementation is not yet justified for knee pain.

RESUMO

Loading both lateral and medial compartments is crucial to understanding the effect of muscle fatigue during sidestep cutting. The present study investigated the changes in tibiofemoral contact forces in the medial and lateral compartments and the muscle force contributions during the sidestep-cutting manoeuvre after a handball-specific fatigue protocol. Twenty female handball athletes performed three trials of the sidestep-cutting manoeuvre before (baseline) and after the fatigue protocol. Motion capture and ground reaction forces were measured, and the data were processed in OpenSim. The variables were compared using statistical parametric mapping (SPM), with a significance level of p < 0.05. The results showed a decreased knee flexion angle during fatigue in the early stance phase. In addition, the post-fatigue analysis demonstrated significantly reduced forces in vasti muscles. Similarly, during fatigue, the SPM analysis showed decreased tibiofemoral contact forces in the vertical and anterior directions. Vertical force applied to both medial and lateral condyles demonstrated a significant reduction after the fatigue protocol. These results indicated that forces applied to the tibiofemoral joint were reduced following the fatigue protocol compared to the baseline values. However, no consistent evidence exists that fatigue increases the risk of knee injuries.

Assuntos

RESUMO

OBJECTIVE: To explore the relationship between knee crepitus, quadriceps muscle thickness and isometric strength in individuals with patellofemoral pain (PFP). DESIGN: Cross-sectional. PARTICIPANTS: Individuals with PFP. MAIN OUTCOME MEASURES: Participants with PFP underwent assessments for presence, frequency and severity of knee crepitus. Real-time ultrasound images of the quadriceps muscles (rectus femoris, vastus medialis and lateralis) at rest and during contraction were obtained, muscle thickness was measured in both conditions. Maximal voluntary isometric contraction tests were performed to measure knee extensor strength. The relationship between knee crepitus and quadriceps muscle thickness and knee extensor strength was explored using logistic and linear regressions. RESULTS: Sixty individuals with PFP were included (age: 24; 60% women; 38% with crepitus). Knee crepitus severity was related to rectus femoris and vastus medialis thickness during rest (R2 = 0.19 and 0.09, respectively) and contraction (R2 = 0.16 and 0.07, respectively) and with vastus lateralis during contraction (R2 = 0.08). Isometric knee extensor strength was not related to knee crepitus presence, frequency, or severity. CONCLUSION: Higher severity of knee crepitus is related to lower quadriceps muscle thickness in individuals with PFP. There is no relationship between the presence and frequency of knee crepitus with quadriceps muscle thickness or knee extensor strength.

Assuntos

RESUMO

To investigate the biomechanical factors associated with patellofemoral pain in children and adolescents. A cross-sectional, population-based study conducted in Brazil from 2019 to 2023, involving students from public schools. Adjusted prevalence ratios and their respective 95% confidence intervals for the outcome in relation to independent variables were calculated for association analysis, adopting a significance level of 5%. Out of the total of 283 students, 152 were female and 182 were aged between 16 and 18 years old. A positive association was observed between the presence of patellofemoral pain and a poor movement quality in both lower limbs (right side: p = 0.04 and left side: p = 0.04) as well as with dynamic valgus of the left lower limb (p < 0.01). Patellofemoral pain in children and adolescents is associated with poor movement quality in the lower limbs and dynamic valgus of the left lower limb. Actions targeting these biomechanical factors may be crucial for early diagnosis and clinical treatment of this disfunction.

Assuntos

RESUMO

PURPOSE: The objective of this study was to describe a planning method for medial unicompartmental knee arthroplasty (UKA) implantation using preoperative stress radiographs to measure the thickness of tibial and femoral bone resections and to validate this method with data from an image-based robotic surgery system. Having such method for preoperative planning would be of interest for surgeons performing UKA in order to anticipate optimal bone resection on both tibia and femoral sides. METHODS: A new planning method for medial UKA based on valgus stress knee radiographs validated it with an image-based robotic surgery system (Restoris MCK, MAKO®, Stryker Corporation) was proposed. This retrospective study involved radiographic measurements of 76 patients who underwent image-based robotic medial UKA between April 2022 and February 2023. Preoperative anteroposterior stress radiographs of the knee were used to simulate UKA implantation. The UKA technique was based on Cartier's angle and aimed at restoring the joint line. The total dimension measured was 14 mm (8 mm for minimal tibial component and polyethylene insert + 4 mm for femoral component + 2 mm for safety laxity). Bone resections were measured in the preoperative valgus stress radiographs and then against the intraoperative bone resection data provided by the robotic system. Inter- and intra-observer reliability was assessed using 25 measurements. RESULTS: The mean planned tibial resection measured in the radiographs was 4.3 ± 0.4 [2.9-5.8], while the mean robotic resection was 4.2 ± 0.5 [2.7-5.8] (mean difference = 0.15 mm, 95% confidence interval [CI] [-0.27 to 0.57]). There was a strong correlation between these two values (Pearson's rank R = 0.79, p < 0.001). Intra- and inter-observer reliability were also very strong (Pearson's rank R = 0.91, p < 0.001, and Pearson's rank R = 0.82, p < 0.001, respectively). The mean planned femoral bone resection measured in the radiographs was 2.7 ± 0.7 mm [1-4.5], while the mean robotic resection was 2.5 ± 0.9 [1-5] (mean difference = 0.21 mm, 95% CI [-0.66 to 1.08]). There was a strong correlation between these two values (Pearson's rank R = 0.82, p < 0.001). Intra- and inter-observer reliability were also strong (Pearson's rank R = 0.88, p < 0.001, and Pearson's rank R = 0.84, p < 0.001, respectively). CONCLUSION: This study describes and validates with robotic information a simple and reproducible preoperative planning method to determine femoral and tibial bone resection for medial UKA implantation using antero-posterior valgus stress knee radiographs, leaving a medial safety laxity of 2 mm. It represents a very valuable contribution to the understanding of UKA principles, which can serve to extend its indications and increase reproducibility of the surgical technique. LEVEL OF EVIDENCE: III. Retrospective cohort study.

RESUMO

Osteoarticular tuberculosis of the knee is an uncommon disease presentation, especially in children under 1 year old. Diagnosis based on classic methods (such as culture and anatomopathological examination) is a challenge due to the paucibacillary characteristic of the infection. Risk factors include contact with individuals with bacilliferous tuberculosis, living in a region with high disease prevalence, and pediatric age group. We describe a case of chronic monoarthritis caused by Mycobacterium tuberculosis and intermittent inflammatory manifestations in a 10-month-old male patient with no extra-articular symptoms and no history of contact with bacilliferous tuberculosis. The culture was negative, and the anatomopathological examination was inconclusive for the etiologic agent. The detection of traces of M. tuberculosis DNA by a rapid molecular test (GeneXpert) based on the polymerase chain reaction technique established the diagnosis. The treatment consisted of antituberculosis drugs and led to complete resolution of the clinical-radiographic picture. This case emphasizes the importance of considering tuberculosis in the initial differential etiologic diagnoses of arthritis and, therefore, the need for an early, specific investigation, even when the clinical suspicion is not high.

RESUMO

BACKGROUND: Total patellectomy is currently reserved for exceptional cases, such as recalcitrant patellofemoral instability and comminuted fractures, due to its demonstrated negative impact on knee biomechanics. Therefore, managing patellectomy is crucial to mitigate its inherent deleterious effects. Various techniques have been described, including autologous or allogeneic bone grafts for reconstruction and soft tissue realignment to enhance the extensor mechanism. CASE SUMMARY: A 73-year-old male underwent a patellectomy due to a comminuted fracture, subsequently developing osteoarthritis and experiencing a decline in functional status. Concurrent with total knee replacement, we conducted a patellar reconstruction, incorporating routine bone cuts and utilizing bone chips to fashion a new patella. This intervention resulted in the restoration of full extension and improvement of knee function. CONCLUSION: Patellar reconstruction demonstrates benefits on knee mechanics and stabilization, contributing to enhanced outcomes and satisfaction following knee replacement. We present an affordable technique for managing patellectomized patients undergoing total knee replacement.

RESUMO

BACKGROUND: The comprehensive core set for knee dysfunction was developed to classify the functioning of people with any knee dysfunction. To be used as a clinical instrument to measure the functioning of people with knee dysfunction, the construct validity of the core set still needs to be assessed. The purpose of this study was to analyze the construct validity of the comprehensive core set for knee dysfunction as an instrument to measure functioning. METHODS: A cross-sectional study with 200 participants with knee dysfunction with or without clinical diagnosis of knee pathology, with or without complaint of pain, with or without instability, and/or with or without knee movement restriction of any type. Participants were assessed using the comprehensive core set for knee dysfunction with 25 categories, the subjective form from the International Knee Documentation Committee scale, and measures of self-perceived general health and functioning. The construct validity of the core set was assessed by Rasch analysis, and the external construct validity was assessed by correlation between the score of the brief core set for knee dysfunction with the subjective form from the International Knee Documentation Committee scale, and scores of self-perception of health and functioning. RESULTS: Twelve categories were consistent with a unidimensional construct, with no difference in the response pattern for age, sex, educational level, and time of complaint. These categories were included in the brief core set for knee dysfunction. The mean score of the brief core set was 37 ± 21 points, a value classified as moderate impairment regarding functioning. Correlations with the subjective form from the International Knee Documentation Committee scale and scores of self-perception were adequate (p < 0.01; r > 0.5). CONCLUSION: The brief core set for knee dysfunction, a set with 12 categories, can be used as a clinical instrument to measure and score the functioning of people with knee dysfunction, aged between 18 and 89 years, with adequate construct validity.

Assuntos